Gastrointestinal Cancers Flashcards by Mike Critchell

What are the various types of cancers (with respect to organs) in the GI tract?

Oesophageal cancer
Gastric cancer
Colorectal cancer
Cholangiocarcinoma
Hepatocellular carcinoma
Pancreatic carcinoma

How well did you know this?

Not at all

Perfectly

What are the various prognoses (5YS) for each type of cancer?

Oesophageal - <10%
Gastric - <20%
Colorectal - (stage B/C) 64-38% (D 3%)
Cholangiocarcinoma - no full data
Hepatocellular - no full data
Pancreatic carcinoma - inoperable 1% (<6m life expectancy), operable 15%

How well did you know this?

Not at all

Perfectly

What histological type of gastric cancer is most common?

Adenocarcinoma

How well did you know this?

Not at all

Perfectly

How do patients with gastric cancer present?

Dyspepsia
Early satiety
Nausea/vomiting
Weight loss
GI bleed
Fe deficient anaemia
Gastric outlet obstruction

How well did you know this?

Not at all

Perfectly

What are the risk factors for gastric cancer?

Diet
Genes
Smoking
H pylori

Family history
Previous gastric resection
Biliary reflux
Premalignant gastric pathology

How well did you know this?

Not at all

Perfectly

What are the symptoms/signs for gastric cancer?

Early satiety
Dyspepsia
Nausea/vomiting
Iron deficiency, anaemia
Gastric outlet obstruction

How well did you know this?

Not at all

Perfectly

What are the alarm features for GI cancer?

Anaemia
Loss of Weight
Anorexia
Recent onset of progressive symptoms
Malaena/haematemesis
Swallowing Difficulty

How well did you know this?

Not at all

Perfectly

What investigations might be done in suspected gastric cancer?

Endoscopy
Contrast Meal
CT chest/Abdom for TNM

How well did you know this?

Not at all

Perfectly

What is the process of managing suspected gastric cancer?

Endoscopy and biopsy for histological diagnosis.
Staging
MDT - fitness for treatment options
(surgical vs chemo)

How well did you know this?

Not at all

Perfectly

What are the surgical options in gastric cancer?

Subtotal gastrectomy
Total gastrecyc and Roux en Y reconstruction
Laparoscopic distal gastrectomy
Open gastrectomy

How well did you know this?

Not at all

Perfectly

What is the most common type of colorectal cancer?

95-98% adenocarcinoma

2/3rds colonic, 1/3rd rectal

How well did you know this?

Not at all

Perfectly

What are the risk factors for colorectal cancer?

FH
IBD
Genetics
- FAP, HNPCC, Peutz-Jeghers

Most (85%) are sporadic

increased age
male
previous adenoma/CRC
diet, obesity, lack of exercise, smoking, DM

How well did you know this?

Not at all

Perfectly

The activation of what oncogenes/loss of what tumour suppressors can turn an adenoma into a carcinoma?

Oncogenes

K-ras
C-myc

Tumour suppressors

General DNA repair pathway genes

How well did you know this?

Not at all

Perfectly

What are the symptoms/signs of colorectal cancer?

Change in bowel habit/continence
Bleeding
Pain (poorly localised)
Non-intestinal manifestations (investigate if >60yo, or 40 if multiple)

How well did you know this?

Not at all

Perfectly

What investigations might be done in suspected colorectal cancer?

Colonoscopy

biopsy/therapeutic (polyp removal)
sedation needed, perforation risk

Barium enema
Virtual CT colonography
CT abdo/pelvis

MRI (+ guided colonoscopy)

How well did you know this?

Not at all

Perfectly

What is the purpose and method of population screening for colorectal cancer?

Detect pre-malignany adenomas early

Faecal occult blood test
Faecal immunochemical test
Endoscopic investigations

Scottish bowel screening programme

50-74yo
FOBT every 2 years
+FOBT? Colonoscopy

How may colorectal cancer be treated?

Surgery is basis of therapy ((80% of patients)

endoscopic/local resection for minimally invasive cancers
stoma formation (permanent or temporary)
removal of lymph nodes for histological analysis
partial hepatectomy for metastases

Chemo

Dukes C and possibly B
if +ve lymph node histology
5-fluorouracil

Radiotherapy

rectal only
with/without chemo to control primary tumour prior to surgery

Palliative for advanced disease

chemo
colonic stenting

What are the various stages of Dukes’ criteria?

A - confined to mucosa
B - extended through mucosa to muscle
C - lymph node involvement
D - distant metastases

What is the rough prognosis (5YS) for colorectal cancer?

Dukes A - 83%

Dukes D - 3%

What is bowel anastomosis? What are key aspects to its success?

Attachment of two previously distant portions of bowel after resection

Tension free
Well perfused/oxygenated
Clean surgical site
Acceptable systemic state

What are risk factors for cholangiocarcinoma?

Primary sclerosing cholangitis
Congenital cystic disease
Biliary-enteric drainage
Thorotrast
Hepatolithiasis
Carcinogens

What are the symptoms/signs of cholangiocarcinoma?

Obstructive jaundice
Itching
Non-specific symptoms

What investigations might be done in suspected cholangiocarcinoma?

Usual lab tests
Radiology
- USS/EUS, CT
- magnetic resonance angiogram
- MRCP/ERCP, FDG-PET, cholangioscopy

How is cholangiocarcinoma treated?

Surgery only potential curative option
- the only option in intrahepatic cholangiocarcinoma

Surgical bypass
Stenting
Palliative radiotherapy
Chemo
Photodynamic therapy
Liver transplant (not standard)

What are the symptoms/signs of hepatocellular carcinoma?

Decompensation of liver disease Abdominal mass/pain Weight loss Bleeding (from tumour)

What investigations might be done in suspected hepatocellular carcinoma?

Tumour markers - AFP Radiological tests Liver biopsy done rarely

What are the treatment options in hepatocellular carcinoma?

Hepatic resection Liver transplant Chemotherapy - local (TACE) or systemic Ablation - alcohol, RFA Sorafenib (TKI) Tamoxifen

What are the different types of oesophageal cancer? Where do they mostly occur?

Adenocarcinoma - distal oesophagus - obesity - GORD, Barrett's Sqaumous cell carcinoma - Proximal/Middle oesophagus - smoking/alcohol - low socio-economic status

How does oesophageal cancer present?

``` Progressive dysphagia (90%) Anorexia/weight loss (75%) Odynophagia Chest pain Cough Pneumonia Vocal cord paralysis Haematemesis ``` Usually presents late - have commonly spread to regional nodes/liver

What investigations might be done in suspected oesophageal cancer?

Endoscopy/biopsy Staging using CT/EUS/PET/Bone scan EUS for TN staging PET CT for M staging

What are the treatment options in oesophageal cancer?

(Metastatic = unfit for surgery, so palliative care) Only potential cure is oesophagectomy with/without adjuvant/neoadjuant chemo (5YS 30%) Require nutritional support

What are the risk factors for pancreatic carcinoma?

Smoking Chronic pancreatitis Adult onset DM Hereditary 75% are duct cell mucinous adenocarcinomas (pancreas head most common site)

Symptoms/signs of pancreatic cancer?

``` Upper abdominal pain Painless obstructive jaundice Weight loss (90%) Anorexia Fatigue Diarrhoea/steatorrhea Nausa/Vomiting Tender subcutaneous fat nodules Ascites, portal hypertension Diabetes Recurrent pancreatitis] ```

What might you find on examination of someone with pancreatic cancer?

``` Hepatomegaly Jaundice (obstructive) Andominal mass/tenderness Ascites/splenomegaly Supraclavicular lymphadenopathy Palpable GB (with ampullary carcinoma) ``` Presence of these (except GB) usually indicate unresectable tumour

What investigations might be done in suspected pancreatic cancer?

Usual imaging (US, CT, MRI, XR) ``` Blood test Laparoscopy + Lap USS Peritoneal cytology PET Tumour markers (CA19-9) ``` Jaundice - ERCP Mass with no jaundice - EUS/percutaneous needle biopsy

Treatment options in pancreatic cancer?

Majority are advanced at presentation, only 10% operable Radical surgery - Whipple's (only if fit, tumour <3cm, no mets) - PPPD alternative Palliation of jaundice - palliative bypass vs ERCP or PTC stenting - duodenal obstruction (bypass vs stent) Pain control Chemo

What is the prognosis in pancreatic cancer?

Inoperable survival <6months (1% 5YS) | Operable 15% 5YS, 30-50% if tumour is ampullary